Improvement of Procedure Documentation Compliance With the Implementation of a Visual Aid.

BACKGROUND: Emergency department (ED) providers face increasing task burdens and requirements related to documentation and paperwork. To decrease the mental task burden for providers, our institution developed an infographic that illustrates which forms are necessary for complete documentation of nonemergent invasive procedures. OBJECTIVES: Our study aims to analyze the effect of a nonelectronic health record-based infographic, paired with direct feedback, on compliance with nonemergent invasive procedure documentation performed in the ED. METHODS: This was a retrospective, observational study of all procedure documentation performed in the ED with a pre-/post-test design. The study included two 8-month study periods, 1 year apart. The preimplementation period used for comparison was January 1, 2019-August 31, 2019, and the postimplementation period was January 1, 2020-August 31, 2020. All invasive procedures that required documentation in addition to a procedure note were included in the study. The primary outcome was the percentage of compliance with documentation requirements. RESULTS: During the pre- and postimplementation study periods, 486 and 405 charts with nonemergent procedures were identified, respectively. In the preimplementation period, 278 (57%) procedures were compliant with all documentation, vs. the postimplementation period, where 287 (71%) procedures were compliant (p < 0.001). CONCLUSION: Implementing an invasive procedure documentation infographic and direct feedback improved overall documentation compliance for nonemergent invasive procedures.

The Effect of a Nursing Hold Team on Patient Satisfaction for Admitted Patients Discharged Directly From the Emergency Department.

OBJECTIVES: Emergency departments (ED) across the United States face challenges related to patient volume, available capacity, and patient throughput. Patient satisfaction is adversely affected by crowding and lengthy boarding times. This study aimed to determine whether the implementation of a dedicated nursing hold team (NHT) would improve patient satisfaction scores for admitted patients discharged directly from the ED. METHODS: This was a retrospective, observational study with a pre-/post-test design. All admitted adult patients who returned a Press Ganey (PG) survey were included in the study. There were two twelve-month study periods before and after implementing an ED NHT. The primary outcome was the percentage of patients who gave top box scores for all questions in the Nursing Communication Domain. RESULTS: During the pre-implementation period, 108 patients (59%) gave an overall top box rating for the Nursing Communication Domain versus the post-implementation period, where 99 patients (66%) provided a top box rating (OR 1.375, p = 0.16). There was a trend toward increased satisfaction for individual categories. However, these differences were not statistically significant. CONCLUSIONS: Implementing a dedicated NHT showed an increase in the overall top box PG Nursing Communication Domain score and several of the individual domain questions. Future studies should examine other potential benefits from a dedicated NHT, such as the rate of adverse events and medication delays.

Escape the Trauma Room.

Traditional conference didactics may not be effectively meeting the learning needs of today's emergency medicine (EM) residents, and educators are employing various interactive approaches to engage learners. Escape Room is a popular adventure game in which participants must work together to solve a series of puzzles to escape a locked room. Our aim was to adapt this game design to teach core EM content and procedural aptitude. Upon entering the "locked" room residents were faced with a series of puzzles involving concepts such as toxicology antidotes, ventilator management, echocardiogram interpretations, airway foreign body removal, arterial line transducer setup, and using a cast cutter. Using teamwork and limited clues learners had to work together to "escape" the room. Afterward, a didactic summary was given to enhance knowledge retention. The Escape Room construct was successfully adopted as an engaging model to teach EM core content and procedure skills while simultaneously fostering team building. Feedback received was overwhelmingly positive. This unique alternative educational activity can be easily implemented at any EM residency program as an effective alternative educational tool.

Resource utilization of adult patients referred to the emergency department from an urgent care center.

BACKGROUND: The rise of urgent care centers (UCC) continues to serve as an alternative to emergency departments (ED) for patients with a perceived lower acuity complaint. Patients that are deemed to be higher acuity are often evaluated at an UCC and then redirected to EDs. However, limited data exist on resource utilization by patients who are transferred from UCCs to EDs. The objective of this study was to compare resource utilization in the ED between patients who were transferred from UCCs and those who were initially evaluated in the ED. METHODS: This was a retrospective study of adult patients transferred from UCCs in Staten Island, NY to Staten Island University Hospital, between 1 March 2018 and 31 December 2018.  The first group (UCC Group) included those initially evaluated at an UCC and then referred to the ED. The second group (ED Group) included those who had their initial evaluation in the ED. RESULTS: 572 subjects were enrolled in the UCC Group, and 84,481 in the ED Group. The UCC Group was more likely to undergo laboratory tests, plain radiographs and computed tomography, electrocardiograms, intravenous fluids, and parenteral medications. Patients in the UCC group were also more likely to be admitted to an inpatient bed or placed into ED observation (p < 0.0001). Overall, ED length of stay was longer in the UCC Group (p < 0.001). CONCLUSIONS: Patients referred from an UCC required more ED resources and were more likely to be admitted to a hospital bed compared to those who initially self-referred to the ED.

Development and Implementation of an Alternate Care Site During the COVID-19 Pandemic.

Introduction With the rampant spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent pandemic of coronavirus disease 2019 (COVID-19), the need for medical resources has never been greater. In recent history, the deployment of surge medical facilities and their importance in improving the provision of crisis care became relevant. The primary objective of this study was to describe the development and implementation of an alternate care site (ACS) during the COVID-19 pandemic. Methods This was a retrospective, single-center study that was conducted between April 7, 2020, and May 26, 2020, of adult patients from a primary facility admitted to an ACS, labeled Staten Island University Hospital East (SIUH-E). These select patients met specific inclusion criteria for SIUH-E before transfer. Results During the operational course of SIUH-E, 813 patients were screened and 203 patients were accepted for transfer. Of the patients admitted to SIUH-E, 120 (59%) were male. The mean age was 63 years (SD = 13.91). The mean length of stay was 3.93 days (SD = 3.94). Among discharged patients, 179 (88%) were discharged to home or another long-term facility, whereas 24 (12%) patients required a transfer back to the main campus. Conclusions In this study, we describe the development and implementation of an alternate care surge facility during the COVID-19 pandemic. SIUH-E played a vital role in effectively caring for select COVID-19 patients, which allowed the primary facilities to treat a greater volume of higher acuity patients. The combined efforts of the state and hospital were able to create and sustain a safe, practical alternative care facility.